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Fetal Hydrops and Heart Failure

Pediatric Cardiology

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Abstract

The recognition of fetal hydrops dates to at least a century ago. This chapter will first review the epidemiology and pathophysiology of fetal hydrops. Given the wide spectrum of causes that lead to fluid imbalances in the fetus, the chapter will focus on the cardiac etiologies which are the most common cause of nonimmune hydrops fetalis, followed by a thorough review of appropriate evaluation including fetal echocardiography to guide the frequency of surveillance and need for treatments based on current guidelines. Echocardiographic findings that establish the diagnosis of hydrops will also be reviewed. Lastly, there will be a discussion of fetal interventions, delivery preparation in fetal hydrops, and findings that are associated with poor outcomes.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia

    Sanghee Suh Ro

  2. Children’s Healthcare of Atlanta, Cardiology, Atlanta, Georgia

    Sanghee Suh Ro

  3. Pediatrics-Cardiology and Medical Social Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Joyce Woo & Angira Patel

Authors
  1. Sanghee Suh Ro
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  2. Joyce Woo
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  3. Angira Patel
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Corresponding author

Correspondence to Angira Patel .

Editor information

Editors and Affiliations

  1. Lurie Children's Hospital, Northwestern Memorial Hospital, Chicago, IL, USA

    Ra-id Abdulla

  2. Lurie Children's Hospital of Chicago, Northwestern Memorial Hospital, Chicago, USA

    Stuart Berger

  3. Lurie Children's Hospital of Chicago, Northwestern Memorial Hospital, Chicago, USA

    Carl Backer

  4. King's College, University College London, London, UK

    Robert Anderson

  5. Weill Cornell Medical College, Cornell University, New York, USA

    Ralf Holzer

  6. University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands

    Nico Blom

  7. Lurie Children's Hospital of Chicago, Northwestern Memorial Hospital, Chicago, IL, USA

    Joshua Robinson

1 Electronic Supplementary Materials

Fetal echocardiogram sweeping from the thorax into the abdomen, demonstrating Ebstein anomaly with small pericardial effusion and ascites. The septal leaflet (SL) of the tricuspid valve is apically displaced and tethered to the ventricular septum. The inflow portion of the right ventricle appears atrialized (MP4 862 kb)

Fetal echocardiogram with color Doppler demonstrating severe pulmonary insufficiency in a fetus with tetralogy of Fallot with absent pulmonary valve. Note the significant main pulmonary artery (MPA) dilation. RVOT right ventricle outflow tract (MP4 909 kb)

Fetal echocardiogram demonstrating dilated cardiomyopathy with pleural and pericardial effusion. There is poor qualitative biventricular systolic function, and qualitatively large cardiac area compared to total thoracic area. R fetus right, L fetus left, PLE pleural effusion, PCE pericardial effusion (MP4 856 kb)

Fetal echocardiogram of a fetal with restrictive ductus arteriosus, demonstrating a discrete area of narrowing (red arrow) (MP4 655 kb)

Fetal echocardiogram demonstrating pericardial effusion and enlarged cardiac area secondary to complete heart block. Note the atrioventricular dyssynchrony, specifically that the atria contract more frequently than the ventricles (MP4 835 kb)

Fetal echocardiogram of fetus with vein of Galen malformation. There is moderate dilation of the right atrium and ventricle, with moderate tricuspid regurgitation. There is also a small pericardial effusion. R fetus right, L fetus left (MP4 788 kb)

Color Doppler interrogation of the umbilical artery in the acardic fetus of twins with twin reversed arterial perfusion (TRAP) sequence. Note that the umbilical artery flows in a reversed direction, from the placenta (P) toward the acardic fetus (AF) (MP4 664 kb)

Fetal echocardiogram of a fetus with supraventricular tachycardia (SVT) and normal intracardiac anatomy, demonstrating cardiomegaly and pleural effusion. In the setting of chamber dilation or difficult visualization of atrial lateral wall movement, rapid movement of the atrioventricular valves may provide a clue to the presence of SVT (MP4 472 kb)

Fetal echocardiogram of a fetus with idiopathic hydrops fetalis and normal intracardiac anatomy, demonstrating large bilateral pleural effusions. R fetus right, L fetus left (MP4 759 kb)

Fetal echocardiogram of a fetus with idiopathic nonimmune hydrops fetalis at 25 weeks of gestation, demonstrating large bilateral pleural effusion and severe ascites leading to intestinal compression (MP4 5784 kb)

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Suh Ro, S., Woo, J., Patel, A. (2023). Fetal Hydrops and Heart Failure. In: Abdulla, Ri., et al. Pediatric Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-42937-9_26-1

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  • DOI: https://doi.org/10.1007/978-3-030-42937-9_26-1

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  • Print ISBN: 978-3-030-42937-9

  • Online ISBN: 978-3-030-42937-9

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  1. Latest

    Fetal Hydrops and Heart Failure
    Published:
    16 May 2024

    DOI: https://doi.org/10.1007/978-3-030-42937-9_26-3

  2. Fetal Hydrops and Heart Failure
    Published:
    26 March 2024

    DOI: https://doi.org/10.1007/978-3-030-42937-9_26-2

  3. Original

    Fetal Hydrops and Heart Failure
    Published:
    08 December 2023

    DOI: https://doi.org/10.1007/978-3-030-42937-9_26-1

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